不同类型假体的全膝关节置换术治疗老年重度内翻畸形膝关节病患者疗效分析

Curative effect of cruciate-retaining and posterior-stabilized total knee arthroplasties in the treatment of elderly patients with severe knee varus deformity

目的:评价老年重度内翻畸形膝关节病患者行全膝关节置换术保留(CR型假体)和不保留(PS型假体)后叉韧带临床效果。方法:选择2010年1月至2015年12月43例在我院行单侧膝关节置换的老年重度内翻畸形膝关节病患者为研究对象,其中CR组(使用CR型假体,保留后叉韧带)23例,PS组(使用PS型假体,不保留后叉韧带)20例,记录并比较PS组与CR组手术前后的血红蛋白变化、美国特种外科医院膝关节评分(HSS评分)及关节活动度(ROM),并记录术后随访中患者Lachman试验。结果:2组患者术前血红蛋白、HSS评分及ROM比较,差异无统计学意义(P>0.05);手术治疗后,2组患者血红蛋白含量、HSS评分及ROM均有一定改善(P<0.05);PS组患者术后12个月ROM明显高于CR组(P<0.05),但术后2组患者血红蛋白含量及HSS评分比较,差异无统计学意义(P>0.05)。CR组术后Lachman试验阳性3例,其中Ⅰ级2例,Ⅱ级1例,阳性率为23%;PS组阳性7例,其中Ⅰ级4例,Ⅱ级3例,阳性率为35%,但差异无统计学意义(P>0.05)。结论:两种膝关节置换术对于老年重度膝内翻畸形的膝关节病患者的疗效均明确,但PS型假体术后关节活动度较CR型假体稍好。

Objective:To evaluate the clinical effect of cruciate-retaining(CR)and posterior-stabilized(PS)total knee arthroplasties(TKA)in the treatment of elderly patients with severe knee varus deformity.Methods:A total of 43 patients with severe knee varus deformity who underwent unilateral knee replacement in our hospital from Jan 2010 to Dec 2015 were enrolled in this study,with 23 cases in CR group and 20 cases in PS group.The hemoglobin level,knee joint HSS score and joint range of motion(ROM)were recorded and compared.The Lachman test was performed at 1 week after surgery.Results:There were no significant differences in hemoglobin level,HSS score and ROM between the two groups before operation(P>0.05).After operation,the hemoglobin level,HSS score and ROM of the two groups were significantly improved(P<0.05).The ROM in the PS group was significantly higher than that in the CR group at 12 months after operation(P<0.05).However,there was no significant difference in hemoglobin level and HSS score between the two groups after operation(P>0.05).There were 3 cases of positive Lachman test in the CR group,including 2 cases of gradeⅠand 1 case of gradeⅡ,with a positive rate of 23%.There were 7 cases of positive lachman test in the PS group,including 4 cases of grade I and 3 cases of grade II,with a positive rate of 35%.Conclusion:Both TKA are effective in the treatment of elderly patients with severe knee varus deformity,however,postoperative ROM of CR-type TKA is lower than that of PS-type TKA.